Get access to this article and to all of thebmj.com for 14 daysSign up today for a 14 day free trial

Michael O’Donnell, writer, broadcaster, and former general practitioner, United Kingdom

mod{at}doctors.org.uk

When I was writing the BBC Radio 4 series The Age Old Dilemma I talked to the relatives of old people who had died in hospital. I also sat in on medical discussions of “care of the dying” and was intrigued by the disparity between the way patients perceived events and the way doctors described the same events when they discussed them with their peers.

That disparity emerged in an article the BMJ published last November telling the story of a 62 year old woman “bed bound with severe arthritis and in constant pain despite strong opioid treatment” (BMJ 2009;339:b4667, doi:10.1136/bmj.b4667). After writing an advanced directive and a detailed suicide note that “clearly expressed [her] distress at her longstanding pain and severe restriction of function and independence” she swallowed a potent concoction of sedatives and sank into what she assumed would be oblivion.

I can only guess at her assumption, because, as is traditional in our journals, her story is written by the doctors. We read in detail the arguments they considered and …